“There is no mortality benefit for that.” How many times have you heard that? The implication is usually the same: that intervention is a waste of time. A smart, evidence-based clinician wouldn’t bother with it. But, what does it actually mean if there is no proven mortality benefit? Several factors conspire to make it nearly impossible to prove mortality benefit in critical care: Mortality is... Read More | Comment

Among patients with severe traumatic brain injury (TBI), early prophylactic hypothermia compared with normothermia did not improve neurologic outcomes at 6 months. These findings do not support the use of early prophylactic hypothermia for patients with severe traumatic brain injury. Among 511 patients who were randomized, 500 provided ongoing consent (mean age, 34.5 years [SD, 13.4]; 402 men [80.2%]) and 466 completed the primary outcome... Read More | Comment

This large randomized clinical trial performed in patients undergoing anesthesia with RSI failed to demonstrate the noninferiority of the sham procedure in preventing pulmonary aspiration. Further studies are required in pregnant women and outside the operating room. Of 3472 patients randomized, mean (SD) age was 51 (19) years and 1777 (51%) were men. The primary end point, pulmonary aspiration, occurred in 10 patients (0.6%) in... Read More | Comment

Powerful drugs that have been used for decades to treat delirium are ineffective for that purpose, according to a study published online Monday in the New England Journal of Medicine. Antipsychotic medications, such as haloperidol (brand name, Haldol), are widely used in intensive care units, emergency rooms, hospital wards and nursing homes. “In some surveys up to 70 percent of patients [in the ICU] get... Read More | Comment

In patients with acute lung injury, compared with full enteral feeding, a strategy of initial trophic enteral feeding for up to 6 days did not improve ventilator-free days, 60-day mortality, or infectious complications but was associated with less gastrointestinal intolerance. Baseline characteristics were similar between the trophic-feeding (n = 508) and full-feeding (n = 492) groups. The full-feeding group received more enteral calories for the... Read More | Comment

In this cluster randomized multicenter study in 13 European ICUs, decontamination strategies with either antibiotics (SDD or SOD) or CHX mouthwash were not associated with reductions in ICU-acquired BSI with MDRGNB, nor mortality, in ventilated ICU patients when compared with standard care, which included universal daily BWs with CHX during ICU stay and a hand hygiene program. Furthermore, the unitwide prevalence of carriage with antibiotic-resistant... Read More | Comment

The study by Wittekamp and colleagues in this issue of JAMA evaluating strategies for decontamination of mechanically ventilated patients in the intensive care unit (ICU) fills an important gap in the evidence regarding these practices. Since the first use of selective decontamination of the digestive tract (SDD) in critically ill patients in the 1980s, the effectiveness of this approach to prevent ICU-acquired infections and reduce... Read More | Comment

A recent study paints a grim picture of what rudeness does to doctors and nurses performance. The study, "The Impact of Rudeness on Medical Team Performance: A Randomized Trial," which was published in the September issue of Pediatrics, shows that a rude comment from a third-party doctor decreased performance among doctors and nurses by more than 50 percent in an exercise involving a hypothetical life-or-death... Read More | Comment

Sepsis resuscitation generally focuses on hemodynamics. Rivers of ink have been spilled writing about oxygen delivery and fluid responsiveness. This is clearly important, but it's possible that our focus on easily observable phenomena has led us to ignore something of equal importance: metabolic resuscitation. We can deliver all the oxygen we want to the tissues, but if the mitochondria are failing it won't work. Clinical... Read More | Comment

Emergency department (ED) visit rates in the United States have been rising over the past 2 decades, outpacing population growth.1 These visits are portrayed in the lay press as unnecessary visits that must be reduced or avoided. Yet a growing body of evidence indicates that most ED visits are medically necessary and that EDs serve as a critical source of care for high-risk patients, including... Read More | Comment

In adult patients with septic shock and high circulating endotoxin activity, does the use of polymyxin B hemoperfusion therapy significantly decrease 28-day mortality? Among patients with septic shock and high endotoxin activity, polymyxin B haemoperfusion treatment plus conventional medical therapy compared with sham treatment plus conventional medical therapy did not reduce mortality at 28 days. High endotoxin activity is associated with multi-organ failure and increased... Read More | Comment

A fungus that thrives in dry soil and warm weather has caused a record number of infections in California. Experts fear climate change will cause it to spread across the western US. Valley fever, a fungal disease that infects an estimated 150,000 people in the US each year and has been on the rise in California. Valley fever, also called coccidioidomycosis, is caused by a... Read More | Comment

A new meta-analysis reveals a positive correlation between incorporating vitamin C in the treatment of sepsis and favorable patient outcomes. Results of the meta-analysis showed a marked reduction in mortality and duration of vasopressor administration in the group with the use of vitamin C, despite varying degrees of statistical significance between the original studies included in this analysis. Sepsis is a severe condition with high... Read More | Comment

A new clinical trial at Emory University and 45 other sites around the U.S. will test a combination of vitamins and steroids in patients diagnosed with sepsis. Sepsis is caused by the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure and death. According to sepsis researchers, sepsis can account for 30 to 50 percent of all hospital deaths,... Read More | Comment

Despite low mean tidal volume in the cohort, a significant percentage of patients were exposed to a prolonged duration of high tidal volumes which was correlated with higher mortality. Detailed ventilator records in the electronic health record provide a unique window for evaluating low tidal volume delivery and targets for improvement. Tidal volumes were analyzed across 1,905 hospitalizations. Although mean tidal volume was 6.8 mL/kg... Read More | Comment

The proportion of pediatric patients undergoing percutaneous extracorporeal membrane oxygenation cannulation is increasing. Mechanical and physiologic complications occur with both methods of cannulation, but percutaneous cannulation appears safe in this cohort. Further analysis is needed to evaluate long-term outcomes with this technique. Of 3,501 patients identified, 77.2% underwent open cannulation, with the frequency of open cannulation decreasing over the study period from approximately 80% to... Read More | Comment

Despite varying degrees of statistical significance between the original studies, this meta-analysis reveals a positive correlation between incorporating vitamin C in the treatment of sepsis and favorable patient outcomes, including better survival and shorter duration of vasopressor use; I2 was shown to be insignificant, and therefore corroborates the consistency of evidence. Since this is a quantitative synthesis of a small number of studies, further randomized... Read More | Comment

Ventilator-dependent patients in the ICU often experience difficulties with one of the most basic human functions, namely communication, due to intubation. Although various assistive communication tools exist, these are infrequently used in ICU patients. Although evidence is limited, results suggest that most communication methods may be effective in improving patient–healthcare professional communication with mechanically ventilated patients. A combination of methods is advised. We developed an... Read More | Comment

Biomarkers represent an essential tool for identification of patients developing infection and to determine their clinical severity. Procalcitonin (PCT) levels appeared to be correlated with the development of severe bacterial infections. Thus, PCT systematic use has been proposed as part of the diagnostic tools and for monitoring treatment duration, but not all of the potential benefits and limitations of PCT have been investigated. We retrospectively... Read More | Comment

If you think you don’t have viruses, think again. It may be hard to fathom, but the human body is occupied by large collections of microorganisms, commonly referred to as our microbiome, that have evolved with us since the early days of man. I am a physician-scientist studying the human microbiome by focusing on viruses, because I believe that harnessing the power of bacteria’s ultimate... Read More | Comment